Wall Street Journal (03.17.13)
To assist India in its fight against TB, the nonprofit Clinton Health Access Initiative and a McGill University professor brokered a deal with several makers of diagnostic equipment to give private Indian laboratories the same discounts on equipment to detect multidrug-resistant TB as is offered to the government of India and other developing countries. The laboratories agreed to a price that is about half of the current market price in India. According to Madhukar Pai, an associate professor at McGill University in Canada and one of the world’s top TB experts, they were able to convince the manufacturers that if the diagnostic equipment were more affordable, a greater number of patients would use them, which would be good for the manufacturers and for TB control.
The Indian Government, with the support of the World Health Organization (WHO), runs a national program that tests and treats patients for free. However, about half of India’s TB patients do not use the government program because they assume that they will receive substandard medical care in the public sector. Instead, they use private medical providers, who may offer cheap, inaccurate tests and inadequate treatments, hence increasing drug-resistant strains.
India’s Central TB Division has not endorsed the new initiative. As a result, it is difficult to determine its impact. It is important for New Delhi’s support of the initiative to persuade private physicians and patient to use the tests. Dr. Navin Dang, a New Delhi laboratory owner and an organizer of the initiative, said that WHO has endorsed all of the discounted diagnostics, and they are widely used globally. Indian TB officials argue that they have not validated some of the tests and even after about a year of pilot tests, the TB division has not adopted GeneXpert, a rapid test to detect TB and drug resistance in two hours.
Dr. Pai and Dr. Dang recently canceled plans to announce the initiative because of the TB Division’s refusal to participate. Pai noted that to get a huge uptake, government’s participation was needed to get the word to private-sector doctors and patients about the tests and the discounted prices. Even a personal visit by Dan and other organizers to the TB Division could not move the officials. The Joint Secretary of Health for India Anshu Prakash, who oversees TB, commented that he was not told why the TB Division did not endorse the initiative, but he suggested that it may have been because a written proposal was not submitted. Prakash also stated that he needed to review a proposal in writing before giving his endorsement.